Effectiveness of Antibiotics for Acute Otitis Media

This literature review explores the effectiveness of antibiotics, specifically cefuroxime and amoxicillin, in treating acute otitis media. It examines the differences between the two antibiotics and their side effects. The review also discusses the methodology used and provides critical appraisal of relevant articles.

Research methods

Table of Contents
INTRODUCTION...........................................................................................................................2
BACKGROUND.............................................................................................................................2
METHODOLOGY..........................................................................................................................3
CRITICAL APPRAISAL................................................................................................................5
DISCUSSION AND RECOMMENDATIONS...............................................................................8
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................10
1

INTRODUCTION
The acute otitis media is refers to infection that is cause within ear. This problem is occur
when the middle ear become infected. The management of this disease is occur by providing
proper analgesia. The antibiotic is provided to patient in order to treat acute otitis media. This
report is about the information of antibiotics regarding acute otitis media. In addition to this, the
question of literature review is that "is cefuroxime more effective than Amoxicillin in reducing
the duration of symptoms of acute otitis media". This literature review helps in projecting the
effectiveness of antibiotics that are used id within the treatment of acute otitis media (Suaya,
2018). This essay is structured including background, methodology, critical appraisal,
discussion, recommendation and conclusion of literature review question. With the help from
this, importance of question can be provided by appropriate sources and evidence.
BACKGROUND
The importance of chosen the public health topic of the effectiveness of cefuroxime better
than Amoxicillin is occur as both the medicines are used to treat bacterial infection within inside
ear. The acute otitis media is a bacterial infection that occurs within the middle of ear. This
infection is occur as painful including other symptoms of allergies and cold. The use of this
medication helps in reducing the risk of this infection. The both medication are used differently
according to allergic condition of patients. The cefuroxime antibiotic is also refers to the
cephalosporin which is used to fight bacterial infection that are present in the body. This
antibiotic is used to treat infection of bacteria that are present within the skin of body including
any part of it (Kujala and et. al., 2017). The concentration of this medication is reached after
providing it dose to patient within one hour after it. It is also required up to 2 days to reduce the
infection according to the symptoms that are appearing due to the present of bacterial infection in
the middle ear. So this medication is used to treat acute otitis media. This infection is highly
occurred in children. Moreover, this antibiotic also provides activity against streptococcus
pneumonia and various other gram-positive bacteria. There are various side effect occur of this
medicine such as vomiting, rash, swelling, nausea, headache, dizziness, etc. The other antibiotic
is used to treat acute otitis media is Amoxicillin. This antibiotic is type of penicillin that helps in
introducing the impact of bacteria by fighting against them. It is also used to treat various
infections that are caused by bacteria which involve pneumonia ear infections and others. This
2

antibiotic initiates fighting against bacteria after the consumption of this medication. The patient
suffer lots of difficulties after consuming this medication as there are the various side effects
occur from this (Mather and et. al., 2019). The high dose of this medication is required as it
cause relief within three days including three times per day. This medication is highly provided
to those patients who do not have allergic reaction from this antibiotic. As it can cause various
several side effects that lead to the worst condition of patient. The side effect of this antibiotic
are occur on the body such as rashes, yeast infection in vaginal, headache, abnormal sense of
taste, stomach upset, etc (Newell and et. al., 2019). These side effects are remaining longer for
14 days and when the patients stop consuming this medication. This antibiotic make patient feel
sick and dizzy. This is occur due to the alteration in digestive system which cause impact on the
absorption of Nutrition. This develops as in dehydration in body from which patient starts feeling
tired and sickness. There are various differences between both antibiotics as they have their
specific role in fighting against bacteria. The cefuroxime is highly recommended to patients who
are allergic to penicillin rather than Amoxicillin. There is also differences occur between the
enzymatic activity of both medicines. The enzymatic activity of cefuroxime is stronger than the
amoxicillin. The providing the conception of cefuroxime dose twice daily e provides positive
impact on the treatment of bacterial infection of ear than dose of Amoxicillin three times within a
day (Rowe and et. al., 2019). The treatment from this antibiotic takes longer according to the
health background of patient. As there are various patients who are allergic to penicillin so this
medication cannot be given to them as it can cause various side effects on their body which can
remain longer for 14 days. So in this case, the cefuroxime antibiotic works for treating the
infection of acute otitis media with two or three days. Mainly, the high dose of antibiotic
amoxicillin is provided in order to treat the acute otitis media do patients per day. The treatment
for pediatric patients is recommended as the use of antibiotic cefuroxime within their infection of
ear. So, this literature review is conducted in order to analyze the effectiveness of antibiotic
regarding the infection of ear.
METHODOLOGY
The literature reviews refers to the summary of research that has previously conducted on a
particular topic. This is occur with help of articles sources and books that are relevant to the area.
The literature review has in determining the nature of literature research. The main objective of
literature review is to provide the acknowledgement of research that has previously conduct.
3

While making literature review it is necessary to understand the nature of it so that it can
properly understand by reader (Seppälä and et. al., 2020). At time of conducting literature
review, the purpose of it must convey properly to the reader by providing the knowledge that has
develop on the topic.
The PICO framework is used in literature review to frame the answer two questions that is
related to the healthcare. It is a mnemonic framework from which a pattern is used to remember
the understanding of answer appropriately. It also helps in developing strategies regarding
literature review. This PICO refers to patient or population, intervention, control and outcome of
any pain, death and infection. This is an effective in clinical question that has arises between
comparison of any health care that is provided to patient. This is an effective process that make
easier in the strategy of literature review by analyzing the key concept that help in developing
answer of the question.
The CINAHL refers to the cumulative index of nursing and allied health literature. This is
the most research database of nursing which provides large number of journals in the context of
nursing and health. This database has chosen within literature review because it really provides
ethical research in the nursing to the entire world (Pichichero and et. al., 2018). It is an
appropriate source from which literature review can we conduct properly with the occurrence of
evidences.
The Boolean operators are simply defined as key words that are used in a search. With the
help of this the more productive and appropriate results can be find out. It also helps in
eliminating any hits scanning that cause error within a research. The most common Boolean
operators are used within the search ARE, AND, OR and NOT.
The limiters help in focusing on the search from which information can be properly
evaluated from the database. This helps in evaluating the information according to making the
search limited so that the values of search can occur appropriately (Vernacchio, 2019).
There is some strength and weaknesses occur of search strategy. The strength includes the
reducing the impact of others involvement within the search. By making on search strategy it
helps in developing parameters from which size of literature can be set or decided according to
the researcher. The weakness of on research is agar is various difficulties while implementing it.
This is occurred due to managing the citation links of publication by self is a long process. There
are different sites that are not provided access to researchers of their database. The truncation
4

proposes to the technique that is used within the database in the form of replacing the ending of a
word with symbol.
There are some major ethical issues and values are necessary while conducting literature.
This includes that the literature review does not harm any perspective. The main aim of literature
review is to make a fact about research so that it can provide welfare. The researcher must
consider the ethical issues of respect that are related to the rights beneficence. They need to make
confidentiality while assessing the information. The other ethical issues are occur as respect for
privacy which is needed to be remain in context of participant (Sigurðsson and et. al., 2018). The
researcher needs to respect the fidelity and dignity of information that is provided to them. This
is occur as a difficult task to achieve as the identity of people that are included within they must
remain confidential among team research. The other ethical issue that has developed in the
research is as informed consent. In this the appropriate information was provided to the people
that are participating within evaluation. The awareness about the project must be provided to all
participants that are involved with in it. The other information must also provide to participant so
that their confidentiality and respect of dignity can be maintained properly. The other ethical
issues are occurred within the voluntary participation. This refers to the participation of people
must be coercion free. The proper authority must be provided to participants so that they can
withdraw in future according to their suitability without development of negative impact on
them. The issue within this becomes challenges among researcher as they can find difficulties in
maintaining the project. This article issues are not be used in literature review as it makes it
unethical.
CRITICAL APPRAISAL
The critical appraisal is defined as a process of identifying the outcome of any literature
review. This also helps in judging the research by its value, relevance and trustworthiness. This
also helps in identify the errors that are present within the outcome of any research (Principi and
et. al., 2017). It also provides support to research with the help of reading it critically. The
literature review can be appraised by with the help of exploring various factors that increase its
reliability. This includes using a table of critical appraisal that help in evaluating the limitation
and provide validity and generalizability of literature.
Article 1 “Diagnosis and treatment of acute otitis media: review”
5

There is a clear statement of aim of this research which is occur as diagnosis and treatment of
acute otitis media. As the article properly describe the treatment and diagnosis that are used
within acute otitis media. The appropriate method of qualitative is used within this article as
research is conduct by identifying the prescription that is used within the case of patients. The
research is design as appropriate as it provides proper analyzing the aim of the research. The data
that has been conducted through research provides recommendation about children's in providing
antibiotics amoxicillin of a 5 day course. The appropriate relationship between participants and
researcher is considered as the proper ethical issues are considered while conducting research on
children. The treatment and diagnostic criteria are properly considered within the case of
children. The data from this analysis is sufficiently progress as it provides the uncertainty that is
present in the diagnostic of 2 year and older patients. It also has been analyzed that the
prescription of antibiotic must be avoided within the case of mild to moderate (Toll and Nunez,
2020). With the help of qualitative methodology the proper research is conducted with the aim of
treatment and diagnosis of acute otitis media. The data that has been collected within this it help
method properly in addressing the issues that is developed in the research regarding the treatment
and diagnosis of infection of ear. The statement from the findings of research is that the
Amoxicillin is recommended to children and young cause of 5 days. This also includes that that
it should not be provided to those patients who are allergic to penicillin. It also has been
evaluated that the methods that are selected helps in providing the benefit of prescription of
antibiotic that are provided to patient within the case of acute otitis media.
Article 2 “Adverse Events of Antibiotics Used to Treat Acute Otitis Media in Children: A
Systematic Meta-Analysis”
This provides clear statement regarding the aim of research is clearly occur it provides
the adverse events of antibiotic which is used to treat acute otitis media in children. The quantity
methodology is appropriate that house in in evaluating the incidence of adverse events that are
linked with medication that is provided to patient including children in order to treat acute otitis
media in them. With this method the proper study is evaluated that help in analyzing the
antibiotics that can be used to treat infection. The requirement strategy is appropriated with the
aim of the research as it properly approaches the participants about the aim of research with the
help of meta-analysis. From this, the various incidents of events are evaluated from which the
antibiotics are judge on the basis of their event that has occur within the children who are having
6

acute otitis media (Hum, 2019). The data has been collected in an appropriate way that provides
the issue that is occur within research. The aim of the research is to characterize the events that
are linked with antibiotics that are provided to children. As the providence of antibiotics to the
children with acute otitis media develop various incidences within studies. The relationship
between researcher and participants is properly considered as while providing antibiotics to
children there dose of antibiotics are considered properly. The article issues are properly
considered while conducting this research as there are children are involved in it. The data
analysis that has been developed is properly rigorous without any harm to children. As the dose
of antibiotics are provided to children according to from lowest to highest. There is a clear
statement of this findings is that the amoxicillin can be used for the treatment of acute otitis
media in children.
Article 3 “Comparison of Efficacy and Safety of Cefpodoxime and Amoxicillin-Clavulanate
Potassium in Paediatric Acute Otitis Media in Children below Two Years: A Prospective
Longitudinal Study”
This is a clear statement of this research is present as the comparison between cefuroxime
and Amoxicillin occur in children who are having below 2 years. The aim of this research is to
analyze the effectiveness of antibiotics from which appropriate treatment can be provided to
children's who are having acute otitis media. The qualitative method is appropriately occur in
this research as the it can be divided into two groups of providing both the antibiotics to analyze
the outcome. The research is designed to analyze the aim of the research so that effective
medicine can be evaluated in context of children that can benefit them within their disease. The
recruitment strategy is appropriate way of analyzing the impact of both the medication that are
provided to children (Gosh and chatterjee, 2017). The recruitment strategy properly develops
with the help of primary and secondary outcome to analyze the adverse events that are occur by
providing these antibiotics to children. The data that has been collected provides appropriate b
within the issue that is within research. The relationship between both researcher and partition
has a properly considered as the researcher can observed the differences between the groups by
observing them. The proper ethical issues that might develop with the involvement of participant
as children are properly consider while conducting this research. The data that has been analyzed
is sufficiently rigorous as it provides the mild adverse event from both drugs that are provided to
children with the help of observing them. This is a clear statement of findings that both the drugs
7

are well tolerated by children who are having mild and limited events after consuming both
antibiotics.
DISCUSSION AND RECOMMENDATIONS
The research of diagnosis and treatment of acute otitis media provides appropriate
interventions with the use of Boolean operators. As the Boolean operators help in developing the
most productive reserves that focus on the aim of the research. So the aim of this resource is
properly analyzed by analyzing the diagnosis and treatment of infection in ear. These
interventions are worked with the help of proper use of operators that provides proper method
with guidelines (Wald and DeMuri, 2018). This also helps in developing the benefits of
antibiotics that are prescribed within the case of acute otitis media among children. the research
of adverse events of antibiotic that are used within the treatment of acute otitis media in children
provides a systematic way of meta-analysis that help in analyzing the incidence of events that are
occur while using antibiotic. The data and research of adverse event was popular collected with
the help of meta-analysis that help clinical to choose the antibiotics appropriately that provides
proper treatment of acute otitis media (Ji, Buffington and Jeske, 2019). The research of
comparison between both antibiotics in children of below 2 years has been providing that the use
of intervention within it provides proper study along with proper primary and secondary
outcome. This helps in in providing the outcome of adverse events that is occur by the
consumption of both antibiotics from different group of children. The above said it has been
recommended that the policies of children regarding their rights must be used while conducting
this research. The treatments for or study that is conduct should be beneficial for children
without any development of negative impact on their health. The proper choosing of an antibiotic
can be reported and can use within the treatment of acute otitis media.
8

CONCLUSION
From the above report it has been concluded that the value of conducting literature review
provides effective ways from which gap and inconsistencies that are present within studies can
easily remove. It also help in clinical areas within the welfare of public health from which
appropriate treatment can be provided to children who are having acute otitis media. The value
of literature review is that it provides contribution to analyze or identify the problems that are
present within research with the help of study. It can also help in developing various new ways
from which research can be interpret. The purpose of literature review is to analyze the
relationship to other. It also provides the originality of problem that is present within the research
and help in justifying methods that are proposed within research.
9

REFERENCES
Books and journals
Ji, L., Buffington, A. and Jeske, B., 2019. In children with acute otitis media, is a 5-day course of
antibiotics as effective as a 10-day course?. Evidence-Based Practice. 22(12). pp.10-11.
Kujala, T., and et. al., 2017. Recurrent acute otitis media detracts from health-related quality of
life. The Journal of Laryngology & Otology. 131(2). pp.128-137.
Mather, M.W., and et. al., 2019. A systematic review and meta-analysis of antimicrobial
resistance in paediatric acute otitis media. International journal of pediatric
otorhinolaryngology. 123. pp.102-109.
Newell, C., and et. al., 2019. Making the Management of Acute Otitis Media a SNAP.
Pichichero, M., and et. al., 2018. Effectiveness of 13-valent pneumococcal conjugate vaccination
for protection against acute otitis media caused by Streptococcus pneumoniae in healthy
young children: a prospective observational study. The Lancet Child & Adolescent
Health. 2(8). pp.561-568.
Principi, N., and et. al., 2017. Acute otitis media with spontaneous tympanic membrane
perforation. European Journal of Clinical Microbiology & Infectious Diseases. 36(1).
pp.11-18.
Rowe, H.M., and et. al., 2019. A Cross-reactive protein vaccine combined with PCV-13 prevents
Streptococcus pneumoniae-and Haemophilus influenzae-mediated acute otitis
media. Infection and immunity. 87(10). pp.e00253-19.
Seppälä, E.M., and et. al., 2020. Picornavirus Infections Are Associated with Acute Otitis Media
in a Prospective Birth Cohort Study. The Journal of Infectious Diseases.
Sigurðsson, S., and et. al., 2018. Reduction in all-cause acute otitis media in children less than
three years of age in primary care following pneumococcal vaccination with PHiD-
CV10: A whole population study. Clinical Infectious Diseases.
Suaya, J.A., 2018. Medical costs for acute otitis media decrease in USA. PharmacoEconomics &
Outcomes News. 816. pp.20-17.
Vernacchio, L., 2019. RE: Analysis of Breastfeeding in" Epidemiology of Acute Otitis Media in
the Postpneumococcal Conjugate Vaccine Era".
Wald, E.R. and DeMuri, G.P., 2018. Antibiotic recommendations for acute otitis media and
acute bacterial sinusitis: conundrum no more. The Pediatric infectious disease
journal. 37(12). pp.1255-1257.
Online
Toll C. W. and Nunez A. D.,2020 Diagnosis and treatment of acute otitis media: review. Online
Available Through :<https://www.cambridge.org/core/journals/journal-of-laryngology-
and-otology/article/diagnosis-and-treatment-of-acute-otitis-media-review/
3C096DF3FFD40B8A2E462945077E6A56>
Hum W. S., 2019. Adverse Events of Antibiotics Used to Treat Acute Otitis Media in Children:
A Systematic Meta-Analysis Online Available Through:<
https://www.jpeds.com/article/S0022-3476(19)31101-1/abstract>
Gosh. A and chatterjee S., 2017. Comparison of Efficacy and Safety of Cefpodoxime and
Amoxicillin-Clavulanate Potassium in Paediatric Acute Otitis Media in Children below
Two Years: A Prospective Longitudinal Study. Online Available
Through :<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535382/>
10

Appendix
Table 1
1. What are the aim (and objectives) of the research study?
.
Article 1: To know whether the selected cases of acute otitis media benefit from antibiotic
prescription
Article 2: To characterize the incidence of adverse events (AEs) associated with antibiotics used
to treat acute otitis media in children.
Article 3: To compare the efficacy and safety of cefpodoxime and amoxicillin-clavulanate
potassium for the treatment of PAOM in children below two years.
Article 4: To describe the extent of which diagnostic methods and written advice were used for
AOM in children 1 to 12 years old.
Article 5: To know whether the selected cases of acute otitis media benefit from antibiotic
prescription
Article 6: To access a therapeutic strategy for acute otitis media of the child in its congestive
namely phase: Is it justified the antibiotic and the place of the analgesic for this stage of otitis
media?
2. What kind of study is it?
Article 1: Randomised controlled trailed
Article 2: Randomized controlled trials, cross-sectional studies, and cohort studies
Article 3: Randomised controlled trailed
Article 4: Cross-sectional study
Article 5: a pooled analysis
Article 6: Randomized controlled trials, cross-sectional studies, and cohort studies
3. Where and when was it done?
11

Article 1: 19th July, 2012
Article 2: 04th August, 2019
Article 3: 11th June, 2017
Article 4: 11th Sep, 2019; Sweden
Article 5: 27th March, 2017
Article 6: 09th March, 2016
4. What kind of participants were involved (people), how many participants were
there and what was their background characteristics
Article 1:
What kind of participants?
Participants were age between 12years to 45years old.
How many participants are there?
Study was carried on over 1663 patients suffering from acute otisis, who were admitted in 15
different hospitals.
What was their background characteristics (e.g. age, ethnicity, sex/gender, education)
Out of 1663 patients; 553 females and rest of were males. All patients were literate except some
children who were pursuing school. They all belongs to middle class and upper class family (No
one were poor).
Article 2:
What kind of participants?
This study is based on secondary research of two researchers from January 1, 1966 to August
25, 2018.
How many participants are there?
It is based on 82 studies in the meta-analysis.
What was their background characteristics (e.g. age, ethnicity, sex/gender, education)
Not available
Article 3:
12

What kind of participants?
Only children age between 6 to 23 months of either sex
How many participants are there?
40 Children
What was their background characteristics (e.g. age, ethnicity, sex/gender, education)
Studying in Primary school, both male and females
Article 4:
What kind of participants?
Children age between 1 to 12
How many participants are there?
27 primary health care centres
What was their background characteristics (e.g. age, ethnicity, sex/gender, education)
Studying in Primary school, both male and females
Article 5:
What kind of participants?
Children age between 3 months to 5 years
How many participants are there?
1124 AOM episodes
What was their background characteristics (e.g. age, ethnicity, sex/gender, education)
Illiterate, Studying in Primary school, both male and females
Article 6:
What kind of participants?
Objects aged between 10 days to 15 years
How many participants are there?
109 patients
What was their background characteristics (e.g. age, ethnicity, sex/gender, education)
Students and new born; either sex
5. What was done in the research and how was information gathered?
Article 1:
13

Medline, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of
Controlled Trials were searched using the key words 'acute otitis media' AND 'diagnosis' OR
'diagnostic criteria' OR 'definition', and by combining the terms 'acute otitis media' AND
'guidelines'. PubMed was searched using the key words 'mastoiditis' and 'prevalence'.
Article 2:
Included 82 studies in the meta-analysis. The incidence of diarrhea, listed from lowest to highest,
was azithromycin (2.2%), placebo (6.9%), low-dose amoxicillin (8.7%), cefdinir (13.0%), high-
dose amoxicillin (13.8%), and high-dose amoxicillin/clavulanate (18.9%). The incidence of
generalized rash, listed from lowest to highest, was azithromycin (1.4%), placebo (2.3%), low-
dose amoxicillin (2.9%), high-dose amoxicillin/clavulanate (4.9%), and high-dose amoxicillin
(6.5%)
Article 3: The study was a prospective longitudinal interventional study conducted in the
Department of Paediatrics of Malda Medical College. Data were received from 40 children from
paediatrics outpatient department over a four month period between June 2016 and September
2016. Inclusion criteria were as follow: Children of either sex between 6 to 23 months, clinically
diagnosed as AOM. Written consent from the parents of the children was obtained and data from
each child was recorded in the case record form. Children with hypersensitivity to study drugs,
hearing loss and toxic signs were excluded from the study. Children below six months of age
were excluded from the study due to their different physiological state.
Article 4: A cross-sectional study was conducted including GPs and STs from primary health
care in Södra Älvsborg County in Southern Sweden, a mixture of urban and rural populations.
All GPs and STs (n = 154) at all publicly and privately owned primary health care centres
(PHCCs) (n = 35) in Södra Älvsborg County were invited to participate in the study in 2012. GPs
and STs were asked to complete a self-administrated questionnaire including demographic data,
diagnostic approach, and the management of AOM (Additional file 1).
Article 5: This pooled analysis included 10 observational studies with similar protocols (eg,
same case definitions, same age grouping, similar sample handling and laboratory procedures
and identical plans for data collection to limit heterogeneity between studies). However, some
modification was allowed to account for potential differences in local acceptability of performing
tympanocentesis in different AOM subpopulations. These studies were conducted between 2007
14

and 2011 in children of 3–59 months of age. In each study, inclusion criteria required a bulging,
diffused or localized inflamed tympanic membrane or spontaneous otorrhea of <24 hours since
symptom onset, accompanied by one of the functional or general signs of otalgia/irritability,
conjunctivitis or fever.
Article 6:
Inclusive Criteria’s: All patients with acute congestive otitis media confirmed otoscopic
examination with a magnifying glass were selected.
Exclusive Criteria’s: All patients with acute otitis media, suppurative or congestive who already
received a therapy with antibiotics and/or analgesic.
Informed consent regarding the procedure was done.
6. What are the key findings mentioned in the discussion section.
Article 1:
Level 1A evidence shows that selected cases of acute otitis media benefit from antibiotic
prescription.
Article 2:
In studies of low-dose amoxicillin, we found a higher incidence of diarrhea in studies that used
daily diaries to collect information about diarrhea and a lower incidence of generalized rash in
studies that reported only rashes judged to be secondary to antibiotic use.
Article 3: The results of this prospective study showed that a 10-day course of cefpodoxime is
therapeutically comparable to amoxicillin-clavulanate potassium in terms of both efficacy and
safety for the treatment of PAOM in children below two years.
Article 4: Otoscopy was by far the most commonly used method for the diagnosis of AOM.
Other diagnostic methods such as pneumatic otoscopy, otomicroscopy and tympanometry were
used to a lesser extent. The GPs used otomicroscopy more often than STs and female GPs and
STs provided written advice to parents more frequently than their male colleagues.
Article 5: The finding that Spn and Hflu were the 2 major pathogens in the pooled analysis is
consistent with results from each of the included studies and provides a more definitive
confirmation of what has been reported in most other published single-country studies.35,36 The
increased proportion of Hflu and moderately decreased proportion of Spn among cases who were
15

PCV7-CRM vaccinated were also consistent with previous reports.
Article 6: The pain control is based on the rational use of analgesic and local and orally. This
phase of otitis as confirmed your study does not necessarily require the use of the antibiotic,
which will consistently influence the classical therapeutic approach of practitioners to learn “the
irrational prescription of antibiotic” with its multiple risks.
7. What do the author’s identify as the strengths and limitations (weaknesses) of
their study?
Article 1:
Article 2:
Article 3: A randomized double blind clinical trial could not be conducted due to lack of
resources. Secondly, the sample sized of our study was relatively small. Thirdly, we did not
perform tympanocentesis to obtain fluid from middle ear for bacteriological culture of the cases
since very often paediatricians start antimicrobial therapy empirically and more importantly to
avoid any inadvertent injury to a child below two years.
Article 4: All GPs and STs at all publicly and privately owned PHCCs in Södra Älvsborg
County were invited to participate, and 27 of 35 of those invited PHCCs participated. The
response rate (74%) at the participating PHCCs was higher than in a previous Swedish survey
Article 5: First, there was statistically significant heterogeneity among the studies included,
despite the use of similar protocols. For example, heterogeneity of PCV7-CRM use across the
included studies limits broad interpretation of potential serotype and pathogen replacement. In an
attempt to control for this, subgroup analyses were performed, the results were weighted, a
random effect model was used and vaccination status was accounted for whenever possible when
formulating the presented conclusions.
Article 6: As previously mentioned by introducing this work, the therapy of acute otitis media is
the subject of controversies, and our validated therapeutic choices in this study, is found in many
works on the thorny problem of antibiotic used in all direction all-out in the treatment of acute
otitis media, especially in its phase congestive.
16

8. What do the author’s identify as the value of the research and what do they recommend for
future research and/or public health policy?
Article 1: Antibiotics were recommended in children two years and younger, most commonly a
5-day course of amoxicillin (or a macrolide in patients allergic to penicillin).
Article 2: The incidence of AEs varies widely depending on which antibiotic is used and how
the information on AEs was collected or reported. The AEs rates reported here may be helpful to
clinicians when choosing an antibiotic to treat acute otitis media.
Article 3: Our study shows that cefpodoxime and amoxicillin-clavulanate are equally effective
in clinically diagnosed cases of PAOM, both in terms of effectiveness and safety in children
below two years.
Article 4: Correct diagnosis is important for avoiding potentially harmful antibiotic treatments,
antimicrobial resistance and possible delay of other diagnoses.
Article 5: The availability of next-generation PCVs should address some residual disease
burden, but replacement and antibiotic resistance make elimination an elusive target. Continued
evaluation of otopathogens is needed to support up-to-date treatment guidelines and inform
decision making for new prevention strategies.
Article 6: The local instillation of drops of an anaesthetic-antiseptic solution in the external
canal is a useful adjuvant in painful congestive viral otitis; Antibiotherapy is only indicated in
suppurative AOM.
Table 2:
Research methods
Part 9–Referencing details of 6 studies (articles)
Authors
(Last Name and Initials)
Sundvall, P., Papachristodoulou, C.E. & Nordeman, L.
Diagnostic
Year published (2019)
Title of article Diagnostic methods for acute otitis media in 1 to 12 year
old children: a cross sectional study in primary health
care.
17

Journal BMC Fam Pract
Volume 127
Issue Number (20)
Page Numbers Pg. 530-536
Authors
(Last Name and Initials)
Ran D. Goldman,
Year published (2017)
Title of article Antibiotic therapy for children with acute otitis media
Journal Can Fam Physician
Volume 63
Issue Number (9)
Page Numbers 685–687
Authors
(Last Name and Initials)
Thomas, J.P., Berner, R., Zahnert, T. and Dazert, S.
Year published (2014)
Title of article Acute Otitis Media—a Structured Approach
Journal Deutsches Ärzteblatt International
Volume 111
Issue Number (9)
Page Numbers 151–160.
Authors
(Last Name and Initials)
Van Dyke, M.K., Pirçon, J.Y., Cohen, R., Madhi, S.A.,
Rosenblüt, A., Parra, M.M., Al-Mazrou, K., Grevers, G.,
Lopez, P., Naranjo, L. and Pumarola, F.
Year published (2017)
Title of article Etiology of acute otitis media in children less than 5 years
of age: a pooled analysis of 10 similarly designed
observational studies
Journal The Pediatric infectious disease journal
18

Volume 36
Issue Number (3)
Page Numbers p.274
Authors
(Last Name and Initials)
Rosenfeld, R.M., Shin, J.J., Schwartz, S.R., Coggins, R.,
Gagnon, L., Hackell, J.M., Hoelting, D., Hunter, L.L.,
Kummer, A.W., Payne, S.C. and Poe, D.S.
Year published (2016)
Title of article Otitis media with effusion (update)
Journal Clinical practice guideline: otitis media with effusion
(update). Otolaryngology–Head and Neck Surgery
Volume 154
Issue Number (1)
Page Numbers pp.S1-S41
Authors
(Last Name and Initials)
Sacko, H.B., Telly, N., Coulibaly, S., Sanogo, H., Fane, S.,
Bagayogo, H.D. and Bouare, M., 2016..
Year published (2016)
Title of article Congestive Acute Otitis Media of Children in Mali with or
without Antibiotic, Place the Analgesic?
Journal Otolaryngology Online Journal.
Volume
Issue Number
Page Numbers
19